Systematic Review and Meta-Analysis Comparing the Surgical Outcomes of Invasive Intraductal Papillary Mucinous Neoplasms and Conventional Pancreatic Ductal Adenocarcinoma
- 727 Downloads
The aim of this study was to summarize the current literature comparing the surgical outcomes of invasive intraductal papillary mucinous neoplasms (IPMNINV) and conventional pancreatic ductal adenocarcinomas (PDAC) in order to determine the differences in disease characteristics and prognosis.
Systematic review of the literature yielded 12 comparative studies reporting the clinicopathological characteristics and overall survival (OS) of 1,450 patients with IPMNINV with 19,304 patients with conventional PDAC.
IPMNINV had a significantly lower likelihood of tumors extending beyond the pancreas [27.6 vs. 94.3 %; T4 vs. T1: odds ratio (OR) 0.111, 95 % confidence intervals (CI) 0.057–0.214], nodal metastasis (45.4 vs. 62.9 %: OR 0.507, 95 % CI 0.347–0.741), positive margin (14.2 vs. 28.3 %; OR 0.438, 95 % CI 0.322–0.596), perineural invasion (49.2 vs. 76.5 %; OR 0.304, 95 % CI 0.106–0.877) and vascular invasion (25.2 vs. 45.7 % OR 0.417, 95 % CI 0.177–0.980) when compared with PDAC. The 5-year OS of IPMNINV was significantly better than PDAC [31.4 vs. 12.4 %: hazard ratio (HR) 0.659, 95 % CI 0.574–0.756]. The tubular subtype had a poorer 5-year OS and demonstrated significantly more aggressive features such as nodal metastases, vascular invasion, and perineural invasion compared with the colloid subtype.
IPMNINV were significantly more likely to present at an earlier stage and were less likely to demonstrate nodal involvement, perineural invasion and vascular invasion. When controlled for stage, IPMNINV had an improved OS when compared with PDAC in the early stages.
KeywordsOverall Survival Vascular Invasion Intraductal Papillary Mucinous Neoplasm Perineural Invasion Tubular Adenocarcinoma
- 4.Longnecker DS, Adler G, Hruban RH, Kloppel G. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Bltonen LA, editors. Pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000:237e40.Google Scholar
- 9.Nara S, Shimada K, Sakamoto Y, Esaki M, Kosuge T, Hiraoka N. Clinical significance of frozen section analysis during resection of intraductal papillary mucinous neoplasm: should a positive pancreatic margin for adenoma or borderline lesion be resected additionally? J Am Coll Surg. 2009;209:614–621.PubMedCrossRefGoogle Scholar
- 10.Crippa S, Fernández-del Castillo C, Salvia R, et al. Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol. 2010;8:213–219.Google Scholar
- 11.Salvia R, Fernandez-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239(5):678–85.Google Scholar
- 15.Waters JA, Schnelldorfer T, Aguilar-Saavedra JR, et al. Survival after resection for invasive intraductal papillary mucinous neoplasm and for pancreatic adenocarcinoma: a multi-institutional comparison according to American Joint Committee on Cancer Stage. J Am Coll Surg. 2011;213(2):275–83.PubMedCrossRefGoogle Scholar
- 19.Japan Pancreas Society. Classification of pancreatic carcinoma. 2nd English ed. Tokyo: Kanehara & Co, Ltd; 2003.Google Scholar
- 20.Sobin LH, Wittekind C; International Union Against Cancer. TNM classification of malignant tumours. 6th ed. New York: Wiley-Liss; 2002.Google Scholar
- 21.Fleming ID, Cooper JS, Henson D, et al. AJCC cancer staging manual. 5th ed. New York: Lippincott-Raven; 1997.Google Scholar
- 22.Schlesselman J, Stolley P. Case-control studies, design, conduct, analysis. New York: Oxford University Press; 1982.Google Scholar
- 26.Mino-Kenudson M, Fernández-del Castillo C, Baba Y, et al. Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut 2011;60(12):1712–20.Google Scholar
- 29.Dickersin K, Berlin JA. Meta-analysis: state-of-the-science. Epidermiol Rev. 1992;14:154–176.Google Scholar
- 34.Goh BK, Thng CH, Tan DM, et al. Evaluation of the Sendai and 2012 International Consensus Guidelines based on initial cross-sectional imaging findings for the management of mucinous cystic lesions of the pancreas: a single institution experience with 114 surgically-treated patients. Am J Surg. Epub 17 Jan 2014.Google Scholar
- 38.Goh BK, Tan DM, Thng CH, et al. Are the Sendai and Fukuoka consensus guidelines for mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single institution experience with 317 surgically-treated patients. Ann Surg Oncol. Epub 7 Feb 2014.Google Scholar
- 39.Goh BK, Tan DM, Ho MF, Lim KH, Chung AY, Ooi LL. Utility of the Sendai consensus guidelines for branch-duct intraductal papillary mucinous neoplasms: a systematic review. J Gastrointestin Surg. In press.Google Scholar
- 40.Fritz S, Fernandez-del Castillo C, Mino-Kenudson M, et al. Global genomic analysis of intraductal papillary mucinous neoplasms of the pancreas reveals significant molecular differences compared to ductal adenocarcinoma. Ann Surg. 2009;249(3):440–7.Google Scholar
- 41.Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.Google Scholar